IUD: The truth behind the most effective—yet, less popular—contraception method

Afina Najib, 26 Oct 2017

IUD contraception method requires insertion of a T-shape device into the uterus.

The use of intrauterine device (IUD) as a method of contraception requires the device to be inserted into the uterus by a health professional. A relatively simple procedure – requiring only a few minutes – IUD is extremely effective with less than one out of 100 women getting pregnant on the device, yearly.
However, the idea of having a device inserted into the uterus has always remained a concern among women; and in some cases, doctors even refuse to give women IUDs.

The Dalkon Shield disaster – a haunting memory

The misconception surrounding IUD started in 1984 when a device called Dalkon Shield was pulled from the market after causing serious medical problems, including perforations and scarring infections in some women. To add to the intricacy of the problem, manufacturers and doctors did not know that the IUD needed to be removed if a woman became pregnant – leading to women dying after miscarrying, with a Dalkon Shield in place.

Dalkon Shield, an old version of IUD that caused complication amongst women in the 1980s. Photo credit: Laura Erickson/Motherboard

Enhanced device; raising awareness through education

Over time, manufacturers developed a safer device and today IUD is amongst the safest and most effective form of birth control. The most severe form of complication is uterine perforation, but it only happens to one in every 1,000 women who receives IUD.

“Once an IUD perforates the uterus, it can move freely into many places, not only in the pelvic cavity, but also in the abdominal cavity,” the report published in the journal Medicine stated.

The report followed a case of a 26-year old Chinese woman who was found with an IUD device in her bladder. The woman had an IUD inserted in 2011, but got pregnant in 2012.

However, the report also stated that a few factors can affect whether or not an IUD punctures a woman’s uterus, such as the type of device she has inserted, when she has it inserted and the way her doctor does the insertion procedure.

To avoid misplacement of IUD, Lauren Streicher, MD, associate clinical professor of gynaecology at Northwestern University’s Feinberg School of Medicine – and author of Sex Rx: Hormones, Health, and Your Best Sex Ever – says that woman should follow a simple method.

“I recommend that a woman assures herself that the IUD is where it needs to be monthly by inserting a finger into her vagina and feeling for a string that hangs out from the IUD,” explains Streicher. “If she can’t feel that string, it’s critical that she come back for a follow up appointment.”

Doctors should also check for patients’ conditions before inserting the device. A current pregnancy, significant risks from the anaesthesia needed for a tubal ligation, or a uterine abnormality may make IUD insertion dangerous – but, apart from that insertion is usually brief and safe.

Doctors in China found an IUD Device in a woman’s bladder after giving birth. Photo credit: Medicine

All contraception bare risk

Supporting the fact is Alyssa Dweck, an OBGYN in Mt. Kisco, New York, and co-author of V Is for Vagina. According to Dr Dweck, all birth control methods carry some health risks. Even so, as long as the patient does not already have an STD or another infection when the IUD is inserted – and uses condoms when one is not in a monogamous relationship – there is little to worry about.

Similar to birth control pills, IUD may cause spotting and cramping in the first year of use and unless a copper IUD is being used, and women may experience hormonal changes and nausea. However, the benefits appear to have outweighed the risk.

IUD is more than 99% effective; can be used as an emergency contraception and used during breastfeeding. In addition, unlike the pill where women are required to quit a few weeks before trying to conceive, IUD can be removed straight away.

“Our data shows IUD users have the fewest amount of problems and complications and the highest continuation rate of any other category of birth control,” says Dr Laura MacIsaac, director of the family planning division at Mount Sinai Health System in New York.

Dr MacIsaac states that most of the fear is a result of a tragic history of the Dalkon Shield, which unlike the current IUD, has a weak design – causing women to bleed and feel pain.

Nonetheless, Dweck assures that insertion of the current IUD will not cause pain.

“Many women don’t feel a thing during insertion, while others experience a twinge or two of pain, like what you feel during a Pap test,” asserts Dweck, adding that taking an OTC painkiller beforehand and making the appointment during the last days of the period – when the cervix is naturally more open – will reduce discomfort. MIMS

At the recent Malaysian Community Pharmacy Business Forum (MyCPBF), a discussion forum was held on the subject of “Transcending Primary Healthcare Services: The Future of Specialized Pharmacy Services and Pharmacy Specialization”.